Prodromal Dementia With Lewy Bodies: Evolution of Symptoms and Predictors of Dementia Onset

Abstract

Background: Research criteria for prodromal dementia with Lewy bodies (DLB) were published in 2020, but little is known regarding prodromal DLB in clinical settings. Methods: We identified non-demented participants without neurodegenerative disease from the National Alzheimer’s Coordinating Center Uniform Data Set who converted to DLB at a subsequent visit. Prevalence of neuropsychiatric and motor symptoms were examined up to 5 years prior to DLB diagnosis. Results: The sample included 116 participants clinically diagnosed with DLB and 348 age and sex-matched (1:3) Healthy Controls. Motor slowing was present in approximately 70% of participants 3 years prior to DLB diagnosis. In the prodromal phase, 50% of DLB participants demonstrated gait disorder, 70% had rigidity, 20% endorsed visual hallucinations, and over 50% of participants endorsed REM sleep behavior disorder. Apathy, depression, and anxiety were common prodromal neuropsychiatric symptoms. The presence of 1+ core clinical features of DLB in combination with apathy, depression, or anxiety resulted in the greatest AUC (0.815; 95% CI: 0.767, 0.865) for distinguishing HC from prodromal DLB 1 year prior to diagnosis. The presence of 2+ core clinical features was also accurate in differentiating between groups (AUC = 0.806; 95% CI: 0.756, 0.855). Conclusion: A wide range of motor, neuropsychiatric and other core clinical symptoms are common in prodromal DLB. A combination of core clinical features, neuropsychiatric symptoms and cognitive impairment can accurately differentiate DLB from normal aging prior to dementia onset.

Clinical symptoms in mild cognitive impairment with Lewy bodies: Frequency, time of onset, and discriminant ability

“…significant and is consistent with data published by other groups on the prevalence of autonomic, neuropsychiatric, and other symptoms in MCI-LB[6][7][8][9][10]. These symptoms are also common in DLB.…”

Neuroimaging Biomarkers in a Patient With Probable Psychiatric-Onset Prodromal Dementia With Lewy Bodies

“…4 However, some studies show that neuropsychiatric symptoms, such as hallucination and apathy, can be identified in cognitively preserved patients many years before the diagnosis of DLB. 5,6 Of note, research criteria for the diagnosis of prodromal DLB have been recently proposed. 7 Psychiatric-onset prodromal DLB is characterized by predominant psychiatric symptoms, which may feature hallucinations in visual and in other modalities, and systematized delusions.…”

A Comparison Between Early Presentation of Dementia with Lewy Bodies, Alzheimer's Disease, and Parkinson's Disease: Evidence from Routine Primary Care and UK Biobank Data

“…Analyses on the prodrome of DLB have so far been limited to core symptoms of DLB. 11,12 Overall, cross-disorder analyses focusing on shared and specific associations with neurodegenerative diseases are rare. 13 We undertook cross-disorder analyses in order to identify prediagnostic associations and risk factors of the most common neurodegenerative conditions (AD, PD, and DLB), using data collected by GPs over a long-time window.…”

“…However, it is unknown how the prodromal features and risk factors of these disorders differ. Analyses on the prodrome of DLB have so far been limited to core symptoms of DLB 11,12 . Overall, cross‐disorder analyses focusing on shared and specific associations with neurodegenerative diseases are rare 13 .…”